Using robots to humanise elderly care

He’s soft, he’s cute and he wants to get your attention. Cuddle him and he’ll respond by turning his head towards you, making eye contact and producing adorable little noises. He’s irresistible – and yet, he’s not alive. Meet Paro, a socially assistive robot in the form of a baby harp seal. He and robots like him represent the future of elderly care.

“A couple of years ago, I suddenly found myself talking to a robot in the form of a dinosaur,” recalls Luc de Witte, professor of Care and Technology at Maastricht University (UM). “It was a strange sensation. I consider myself a fairly rational man, but there was something so compelling about that robot that I couldn’t help but interact with him.” It was this experience that triggered his interest in the field of robotics and its potential to assist in care provision in our ageing society.

We’re not only getting older on average; in the coming decades the absolute number of seniors in the Western world will dramatically increase. That this development presents major challenges to the quality of our healthcare system is beyond dispute. The idea that these could be met by using robot technology, however, is subject to fierce debate. “Caregiving is commonly seen as a labour of love, whereas robots are seen as representing a move towards dehumanisation”, explains Roger Bemelmans. In his PhD research, supervised by De Witte, he investigated how the use of the robotic toy seal Paro in nursing homes could improve care for dementia patients.

Paro

Bemelmans: “When I started reviewing the literature on socially assistive robots, I realised little was known about the effects and effectiveness of robot interventions aimed at social assistance in elderly care. And only a few of the robot systems available were actually operational.” Paro, the adorable white fluff ball, proved to be the best option – there’s more to this stuffed animal than meets the eye. He can distinguish between light and dark, knows when he is being stroked or held, and can recognise his own name. Moreover, his behaviour is not entirely deterministic: he has the capacity to learn and thus to develop, in a manner of speaking, his own personality.

“Paro appeals to very basic emotions, such as the urge to care for someone and to give and receive attention”, says De Witte. “Virtually everybody starts talking to him, cuddling him. It just happens automatically.” Until recently, Paro was a wonderful gadget, but not much more than that. “We wanted to go one step further,” Bemelmans explains, “and identify real-life problems which could be addressed by a purposeful intervention within the walls of nursing homes. That’s what makes our research innovative, and hitherto unique.”

Intervention

It was an ambitious enterprise: doctors, therapists, psychologists, caregivers and family members of dementia patients needed to be convinced of the potential benefits of working with Paro. “It took one and a half years and a lot of talking and organising to get our foot in the door”, Bemelmans says. “Luc, having a powerful network, was of great help in that respect.” Eventually, five nursing homes agreed to cooperate.

Next, a specific care problem was identified for each individual participant. De Witte: “People suffering from dementia can be agitated, aggressive or restless. One of the participants, for example, often displayed problem behaviour when visiting the pedicurist. Two staff members needed to accompany her to just to allow the pedicurist to do her job. The idea was that Paro would be deployed to help things go more smoothly.” A predefined set of indicators was used regularly to measure the psychological functioning and psychosocial wellbeing of the participants as well as the extent to which Paro facilitated care providers in their work.

Added value

“For patients, we found that the introduction of Paro had definite added value. We’re still investigating exactly how and why it works, yet it works”, says Bemelmans. “For the caregivers, the picture looks a bit different. Dealing with Paro was yet another task they needed to combine with their daily care activities, which initially turned out to be very complicated. Later on, however, their experiences became increasingly positive. We interpret this as an encouraging signal that points to the need for further research.”

“What I find significant is the fact that many of the caregivers who took part in our research have asked their managers to invest in Paro robots”, De Witte adds. “They’ve seen that Paro is a tool which can help them, not a machine that will make them redundant. Our task is to look for ways in which we can improve quality and add value to the health care system. That search doesn’t end as soon as a PhD thesis is finished; it’s an ongoing process.”

Luc de Witte (1959) studied medicine at UM, where he obtained his PhD in 1991. He worked as a researcher at the department of Health Promotion and later Medical Sociology, and occupied a variety of positions at the Institute for Rehabilitation Research in Hoensbroek. Currently, he is professor of Care and Technology at UM and Zuyd University of Applied Sciences in Heerlen. He is also director of the Centre of Expertise on Innovative Care and Technology (EIZT).

Roger Bemelmans (1972) studied computer science at Zuyd University of Applied Sciences in Heerlen, followed by knowledge engineering and operational research at UM. He became a computer science lecturer at Zuyd University in 1998 and has also been a researcher at the Research Centre for Technology in Care since 2008. He received his PhD on the use socially assistive robots in intramural psychogeriatric care in November 2015.